Obama and the Republicans on health care – the Baltimore dialogue

President Obama’s recent visit to Baltimore to speak with (as he said, “not to, but with”) the House Republican Conference was one of the best things to happen in politics in recent memory.
Not that there’s a long list.
During the 90 minute dialogue, health care came up many times, first during the President’ opening remarks. There’s a lot there and much of it is encouraging, positive, and helpful. I’ve excerpted what I think are the most meaningful and interesting passages below, but for those disinclined to read this much, here’s my take.
This was an honest, open dialogue, with a bit of demagoging on the part of a couple (mostly freshman) GOP Congressmen. It was clear that the President had read most, if not all, of their proposals and ideas on health care, had considered them carefully, and some were included in the final bills. But let’s be clear – Congress came up with all the legislation, not the President. There was no “ObamaCare”, despite the use of that term by some in the media.
There is indeed opportunity for some common ground on health reform – perhaps around establishing national health insurance standards combined with opening insurance markets across state lines and perhaps tort reform, although anyone who thinks tort reform is a magic bullet hasn’t looked objectively at the issue.
But that said, both steps would help get something started, a ‘something’ that might break the legislative logjam currently preventing anything at all from getting done.
Here’s hoping the Baltimore dialogue will be viewed as the first step in meaningful health reform legislation.
The President’s opening remarks:

I know how bitter and contentious the issue of health insurance reform has become. And I will eagerly look at the ideas and better solutions on the health care front. If anyone here truly believes our health insurance system is working well for people, I respect your right to say so, but I just don’t agree. And neither would millions of Americans with preexisting conditions who can’t get coverage today or find out that they lose their insurance just as they’re getting seriously ill…I don’t think a system is working when small businesses are gouged and 15,000 Americans are losing coverage every single day; when premiums have doubled and out-of-pocket costs have exploded and they’re poised to do so again.
I mean, to be fair, the status quo is working for the insurance industry, but it’s not working for the American people. It’s not working for our federal budget. It needs to change.
This is a big problem, and all of us are called on to solve it. And that’s why, from the start, I sought out and supported ideas from Republicans. I even talked about an issue that has been a holy grail for a lot of you, which was tort reform, and said that I’d be willing to work together as part of a comprehensive package to deal with it. I just didn’t get a lot of nibbles.
Creating a high-risk pool for uninsured folks with preexisting conditions, that wasn’t my idea, it was Senator McCain’s. And I supported it, and it got incorporated into our approach. Allowing insurance companies to sell coverage across state lines to add choice and competition and bring down costs for businesses and consumers — that’s an idea that some of you I suspect included in this better solutions; that’s an idea that was incorporated into our package. And I support it, provided that we do it hand in hand with broader reforms that protect benefits and protect patients and protect the American people.
A number of you have suggested creating pools where self-employed and small businesses could buy insurance. That was a good idea. I embraced it. Some of you supported efforts to provide insurance to children and let kids remain covered on their parents’ insurance until they’re 25 or 26. I supported that. That’s part of our package. I supported a number of other ideas, from incentivizing wellness to creating an affordable catastrophic insurance option for young people that came from Republicans like Mike Enzi and Olympia Snowe in the Senate, and I’m sure from some of you as well. So when you say I ought to be willing to accept Republican ideas on health care, let’s be clear: I have.

Next, in response to a question from Chaffetz, who said “…when you stood up before the American people multiple times and said you would broadcast the health care debates on C-SPAN, you didn’t. And I was disappointed, and I think a lot of Americans were disappointed.
Obama
” Look, the truth of the matter is that if you look at the health care process — just over the course of the year — overwhelmingly the majority of it actually was on C-SPAN, because it was taking place in congressional hearings in which you guys were participating. I mean, how many committees were there that helped to shape this bill? Countless hearings took place.
Now, I kicked it off, by the way, with a meeting with many of you, including your key leadership. What is true, there’s no doubt about it, is that once it got through the committee process and there were now a series of meetings taking place all over the Capitol trying to figure out how to get the thing together — that was a messy process. And I take responsibility for not having structured it in a way where it was all taking place in one place that could be filmed. How to do that logistically would not have been as easy as it sounds, because you’re shuttling back and forth between the House, the Senate, different offices, et cetera, different legislators. But I think it’s a legitimate criticism. So on that one, I take responsibility.”
Blackburn
“thank you for acknowledging that we have ideas on health care because, indeed, we do have ideas, we have plans, we have over 50 bills, we have lots of amendments that would bring health care ideas to the forefront. We would — we’ve got plans to lower cost, to change purchasing models, address medical liability, insurance accountability, chronic and preexisting conditions, and access to affordable care for those with those conditions, insurance portability, expanded access — but not doing it with creating more government, more bureaucracy, and more cost for the American taxpayer.
And we look forward to sharing those ideas with you. We want to work with you on health reform and making certain that we do it in an affordable, cost-effective way that is going to reduce bureaucracy, reduce government interference, and reduce costs to individuals and to taxpayers.”
Obama
“I’ve gotten many of your ideas. I’ve taken a look at them, even before I was handed this. Some of the ideas we have embraced in our package. Some of them are embraced with caveats. So let me give you an example.
I think one of the proposals that has been focused on by the Republicans as a way to reduce costs is allowing insurance companies to sell across state lines. We actually include that as part of our approach. But the caveat is, we’ve got to do so with some minimum standards, because otherwise what happens is that you could have insurance companies circumvent a whole bunch of state regulations about basic benefits or what have you, making sure that a woman is able to get mammograms as part of preventive care, for example. Part of what could happen is insurance companies could go into states and cherry-pick and just get those who are healthiest and leave behind those who are least healthy, which would raise everybody’s premiums who weren’t healthy, right?
So it’s not that many of these ideas aren’t workable, but we have to refine them to make sure that they don’t just end up worsening the situation for folks rather than making it better.
Now, what I said at the State of the Union is what I still believe: If you can show me — and if I get confirmation from health care experts, people who know the system and how it works, including doctors and nurses — ways of reducing people’s premiums; covering those who do not have insurance; making it more affordable for small businesses; having insurance reforms that ensure people have insurance even when they’ve got preexisting conditions, that their coverage is not dropped just because they’re sick, that young people right out of college or as they’re entering in the workforce can still get health insurance — if those component parts are things that you care about and want to do, I’m game…
The component parts of this thing are pretty similar to what Howard Baker, Bob Dole, and Tom Daschle proposed at the beginning of this debate last year...
But if you were to listen to the debate and, frankly, how some of you went after this bill, you’d think that this thing was some Bolshevik plot. No, I mean, that’s how you guys — (applause) — that’s how you guys presented it.
And so I’m thinking to myself, well, how is it that a plan that is pretty centrist — no, look, I mean, I’m just saying, I know you guys disagree, but if you look at the facts of this bill, most independent observers would say this is actually what many Republicans — is similar to what many Republicans proposed to Bill Clinton when he was doing his debate on health care.
So all I’m saying is, we’ve got to close the gap a little bit between the rhetoric and the reality. I’m not suggesting that we’re going to agree on everything, whether it’s on health care or energy or what have you, but if the way these issues are being presented by the Republicans is that this is some wild-eyed plot to impose huge government in every aspect of our lives, what happens is you guys then don’t have a lot of room to negotiate with me.
I mean, the fact of the matter is, is that many of you, if you voted with the administration on something, are politically vulnerable in your own base, in your own party. You’ve given yourselves very little room to work in a bipartisan fashion because what you’ve been telling your constituents is, this guy is doing all kinds of crazy stuff that’s going to destroy America.
And I would just say that we have to think about tone. It’s not just on your side, by the way — it’s on our side, as well.”
Price
“Mr. President, multiple times, from your administration, there have come statements that Republicans have no ideas and no solutions. In spite of the fact that we’ve offered, as demonstrated today, positive solutions to all of the challenges we face, including energy and the economy and health care, specifically in the area of health care — this bill, H.R.3400, that has more co-sponsors than any health care bill in the House, is a bill that would provide health coverage for all Americans; would correct the significant insurance challenges of affordability and preexisting; would solve the lawsuit abuse issue, which isn’t addressed significantly in the other proposals that went through the House and the Senate; would write into law that medical decisions are made between patients and families and doctors; and does all of that without raising taxes by a penny.”
[editorial comment – this is bald-faced BS. health coverage for all Americans that doesn’t raise taxes by a penny? What utter nonsense!]
Obama
” It’s not enough if you say, for example, that we’ve offered a health care plan and I look up — this is just under the section that you’ve just provided me, or the book that you just provided me — summary of GOP health care reform bill: The GOP plan will lower health care premiums for American families and small businesses, addressing America’s number-one priority for health reform. I mean, that’s an idea that we all embrace. But specifically it’s got to work. I mean, there’s got to be a mechanism in these plans that I can go to an independent health care expert and say, is this something that will actually work, or is it boilerplate?
If I’m told, for example, that the solution to dealing with health care costs is tort reform, something that I’ve said I am willing to work with you on, but the CBO or other experts say to me, at best, this could reduce health care costs relative to where they’re growing by a couple of percentage points, or save $5 billion a year, that’s what we can score it at, and it will not bend the cost curve long term or reduce premiums significantly — then you can’t make the claim that that’s the only thing that we have to do.”
What does this mean for you?
A glimmer of hope for change.